A Digestive Cartridge Reduces Parenteral Nutrition Dependence and Increases Bowel Growth in a Piglet Short Bowel Model.

Autor:	Tsikis ST; Vascular Biology Program, Boston Children's Hospital, Harvard Medical School, Boston, MA.; Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA., Fligor SC; Vascular Biology Program, Boston Children's Hospital, Harvard Medical School, Boston, MA.; Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA., Hirsch TI; Vascular Biology Program, Boston Children's Hospital, Harvard Medical School, Boston, MA.; Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA., Mitchell PD; Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, MA., Pan A; Vascular Biology Program, Boston Children's Hospital, Harvard Medical School, Boston, MA.; Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA., Moskowitzova K; Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA., Whitlock AE; Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA., Loring G; Alcresta Therapeutics, Newton, MA., First E; Alcresta Therapeutics, Newton, MA., Nedder A; Animal Care Resources Children's Hospital, Boston Children's Hospital, Boston, MA., Gura KM; Department of Pharmacy and the Division of Gastroenterology and Nutrition, Boston Children's Hospital, Harvard Medical School, Boston, MA., Puder M; Vascular Biology Program, Boston Children's Hospital, Harvard Medical School, Boston, MA.; Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA.
Jazyk:	angličtina
Zdroj:	Annals of surgery [Ann Surg] 2023 Oct 01; Vol. 278 (4), pp. e876-e884. Date of Electronic Publication: 2023 Mar 16.
DOI:	10.1097/SLA.0000000000005839
Abstrakt:	Objective: To determine whether the use of an immobilized lipase cartridge (ILC) to hydrolyze fats in enteral nutrition (EN) reduces parenteral nutrition (PN) dependence in a porcine model of short bowel syndrome with intestinal failure (SBS-IF). Background: SBS-IF occurs after intestinal loss resulting in malabsorption and PN dependence. Limited therapeutic options are available for achieving enteral autonomy. Methods: Eleven Yorkshire piglets underwent 75% jejunoileal resection and were randomized into control (n=6) and treatment (n = 5) groups. PN was initiated postoperatively and reduced as EN advanced if predefined clinical criteria were fulfilled. Animals were studied for 14 days and changes in PN/EN calories were assessed. Intestinal adaptation, absorption, and nutrition were evaluated at the end of the study (day 15). Comparisons between groups were performed using analysis of covariance adjusted for baseline. Results: ILC animals demonstrated a 19% greater reduction in PN calories ( P < 0.0001) and higher mean EN advancement (66% vs 47% of total calories, P < 0.0001) during the 14-day experiment. Treatment animals had increased intestinal length (19.5 vs 0.7%, P =0.03) and 1.9-fold higher crypt cell proliferation ( P =0.02) compared with controls. By day 15, ILC treatment resulted in higher plasma concentrations of glucagon-like peptide-2 ( P = 0.02), eicosapentaenoic acid ( P < 0.0001), docosahexaenoic acid ( P = 0.004), vitamin A ( P = 0.02), low-density lipoprotein ( P = 0.02), and high-density lipoprotein ( P = 0.04). There were no differences in liver enzymes or total bilirubin between the two groups. Conclusions: ILC use in conjunction with enteral feeding reduced PN dependence, improved nutrient absorption, and increased bowel growth in a porcine SBS-IF model. These results support a potential role for the ILC in clinical SBS-IF. Competing Interests: M.P. and K.M.G. receive research support and advisory compensation from Alcresta Therapeutics, Inc. (Newton, MA). G.L. and E.F. were employees of Alcresta Therapeutics, Inc. at the time of the study. The remaining authors report no conflicts of interest. (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)
Databáze:	MEDLINE
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